Turan Muberra, Sozen Fisun, Eminsoy Muzaffer G, Sencelikel Tugce, Kut Altug, Yildirim Sedat, Oksuz Ergun
Family Medicine, Baskent University Faculty of Medicine, Ankara, TUR.
Biostatistics, Baskent University Faculty of Medicine, Ankara, TUR.
Cureus. 2021 Sep 2;13(9):e17662. doi: 10.7759/cureus.17662. eCollection 2021 Sep.
Objectives We aimed to investigate the effectiveness of physician-performed diagnostic clinical breast examination (DCBE) for the diagnosis of breast cancer in clinical practice and to determine the rates of breast cancer diagnosed with DCBE compared to the results of breast ultrasonography (US), mammography (MG), and histopathology. Methods In the retrospective cohort study, the files of female patients diagnosed with breast cancer and admitted to the general surgery outpatient clinics of a university hospital over a 10-year period (2011-2021) were examined. Patients with complete DCBE findings in their files were identified and analyzed (n = 1,091). The examinations of the patients were performed by general surgery specialists with 5-22 years of experience and by radiologists with 4-15 years of experience. Results The mean age of breast cancer diagnosis of the patients was 55.1 ± 13.5 years. While the sensitivity of DCBE was found to be 88.9%, MG sensitivity was 89.8% and breast US sensitivity was 95.1%. Cancer was detected by MG, breast US, and DCBE in 47.9% (n = 523), by breast US and DCBE in 38.9% (n = 424), by MG and breast US in 5.6% (n = 61), by DCBE alone in 3.6% (n = 39), by MG and DCBE in 2.4% (n = 26), and by breast US alone in 1.6% (n = 18). Early-stage breast cancer (p = 0.00) consisted of 73.2% (n = 383) of cancers detected with DCBE, breast US and MG, 74.6% (n = 316) of cancers detected with DCBE and breast US, 93.4% of cancers detected with breast US and MG (n = 57), 92.3% (n = 24) of cancers detected with DCBE and MG, 94.4% (n = 17) of cancers detected with breast US alone, and 69.2% of cancers detected with DCBE alone (n = 27). Conclusions CBE still maintains its importance in societies where screening participation and awareness of breast cancer are low. A breast cancer diagnosis is often done after a complaint of a palpable mass in the breast, and only then are more advanced-stage breast cancers are seen. CBE is among the important diagnostic methods preventing breast cancer from being overlooked, especially in places where health resources are limited.
目的 我们旨在研究临床实践中医生进行的诊断性临床乳腺检查（DCBE）对乳腺癌诊断的有效性，并确定与乳腺超声（US）、乳腺钼靶（MG）和组织病理学结果相比，通过DCBE诊断出的乳腺癌的比例。方法 在这项回顾性队列研究中，检查了一所大学医院普通外科门诊在10年期间（2011 - 2021年）收治的被诊断为乳腺癌的女性患者的病历。确定并分析了病历中具有完整DCBE检查结果的患者（n = 1091）。患者的检查由具有5 - 22年经验的普通外科专家和具有4 - 15年经验的放射科医生进行。结果 患者乳腺癌诊断的平均年龄为55.1±13.5岁。DCBE的敏感性为88.9%，MG的敏感性为89.8%，乳腺US的敏感性为95.1%。通过MG、乳腺US和DCBE检测到癌症的占47.9%（n = 523），通过乳腺US和DCBE检测到癌症的占38.9%（n = 424），通过MG和乳腺US检测到癌症的占5.6%（n = 61），仅通过DCBE检测到癌症的占3.6%（n = 39），通过MG和DCBE检测到癌症的占2.4%（n = 26），仅通过乳腺US检测到癌症的占1.6%（n = 18）。早期乳腺癌（p = 0.00）在通过DCBE、乳腺US和MG检测到的癌症中占73.2%（n = 383），在通过DCBE和乳腺US检测到的癌症中占74.6%（n = 31,6），在通过乳腺US和MG检测到的癌症中占93.4%（n = 57），在通过DCBE和MG检测到的癌症中占92.3%（n = 24），在仅通过乳腺US检测到的癌症中占94.4%（n = 17），在仅通过DCBE检测到的癌症中占69.2%（n = 27）。结论 在乳腺癌筛查参与率和意识较低的社会中，CBE仍然保持其重要性。乳腺癌诊断通常在患者主诉乳房可触及肿块后进行，此时往往只能发现更晚期的乳腺癌。CBE是防止乳腺癌被漏诊的重要诊断方法之一，尤其是在卫生资源有限的地区。
